Safety of surgery in elderly

The problem of surgery in an increasingly ageing population worldwide is reviewed. The outcome in a prospective study of 505 patients admitted to a general surgical unit is considered and the risks determined. The factors leading to poor results such as emergency surgery, multiple operations, duration of operation, age itself and the physical status of the patient are examined and evaluated. The overall mortality rate in the study was 14.5%, with 12% for major operations, 6.1% for minor procedures and 24.3% for those who had no operation. The unsatisfactory nature of existing systems of audit are discussed and a new system of audit is proposed which takes into account and defines the 'non-viable' and the 'potentially viable' patient. When this system was applied to the study there was a significant drop in the overall mortality from 14.5% to 3.6%, from 12.0% to 5.8% for major operations, from 6.1% to 0% for minor operations and from 24.3% to 2.0% for those with no surgery. Finally recommendations are made to improve the safety of surgery in the elderly.